A strategy to prevent excess fluid absorption in trans-cervical endometrial resection

Summary

Fluid balance was recorded in 246 consecutive patients having transcervical endometrial resection, and serum sodium in 49. In 221 glycine was infused at a pressure of 100 cm of water, while in 25 women the pressure was adjusted to the minimum required to produce uterine distension adequate for safe resection. In no case were there any clinical symptoms or signs of fluid overload although three of 49 women developed mild hyponatraemia. The two most severe cases were associated with glycine absorption in excess of 1 -5 litres. Operating time was correlated with fluid absorption, and submucous fibroids were associated with greater fluid absorption. Neither tubal ligation nor pre-operative hormone treatment to thin the endometrium had an effect on fluid absorption. The median infusion pressure required was 100 cm of water (interquartile range 88-105).

It is concluded that 1-5 litres should be the maximum fluid deficit allowed, that an operating time in excess of 30 min and the resection of submucous fibroids are both risk factors for excess fluid absorption, and that infusion pressures in the region of 100 cm of water are safe and may lead to less fluid absorption.